AB1282 CLINICAL AND RADIOLOGICAL FEATURES IN BRUCELLA SPONDYLODISCITIS: A DESCRIPTIVE STUDY
Authors: M. Ghanmi, N. El Fani, S. Mtawaa, R. Moncer, M. Gaddour, W. Wanes, S. Jemni
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Spondylodiscitis is an infectious inflammation that affects the vertebrae, vertebral discs and adjacent structures. Vertebral involvement during brucellosis is considered not only as the most frequent localization but also as the most severe one. <h3>Objectives</h3> The aim of the present study was to describe the clinical and the magnetic resonance imaging features of brucella spondylodiscitis. <h3>Methods</h3> We conducted a retrospective study including 11 patients who have presented in the outpatient clinics of physical medicine and rehabilitation for spinal brucellosis with or without neurological disorders from 2016 to 2021. The diagnosis of brucellosis was based on clinical symptoms, MRI findings and isolation of brucella species in blood or tissue specimens and/or a positive Wright agglutination test. <h3>Results</h3> Eleven patients were included. The mean age was 52.5 years [33-74] (6 males and 5 female). The consumption of unpasteurized dairy was found in 4 patients. The main symptom was an inflammatory back pain and it was found in all patients. It was associated with radiculopathy in 8 cases. The other clinical symptoms were fever in 10 patients, sweats in 4 cases, weight loss in 4 cases and hepatomegaly in 1 patient. The median delay before diagnosis was 5,2 months [1-7]. On examination, we revealed tenderness on palpation in 10 cases and muscular weakness of lower limbs in 5 cases. Brucella agglutination test was ≥1/160 in all cases. Blood cultures were negative in all cases. Median erythrocyte sedimentation rate (ESR) and serum C-reactive protein level were 42 mm and 15 mg/dl respectively. Spondylodiscitis was located in the lumbar dorsal and cervical spine in respectively 8, 2 and 1 cases. The involvement of more than 2 vertebrae was found in 2 cases. The most affected level were the L4-L5 level in 3 cases followed by the T10-T11 level in 2 cases. Associated sacroiliitis was found in one patient. All MRI images of the affected vertebrae showed hypo intense signal on T1 weighted image and hyper intense signal on T2 weighted image. Disc space narrowing was documented in 8 cases. Vertebral body osteolysis was found in 5 cases. Epidural collection was found in 3 cases with a size up to 5cm. Paravertebral and peri-vertebral abscesses were detected in 3 cases. Intradiscal abscesses were observed in 2 cases. Cord compression and involvement of root nerve were noted in respectively 5 and 1 cases. Biopsy was performed in 5 cases, but bacteriological examination was contributory to the diagnosis in 1 case. All patients received antibiotic treatment with a combination of two or three drugs, corticosteroids were prescribed in 5 patients and four patient underwent a surgical intervention. <h3>Conclusion</h3> Although not always specific, MRI findings associated with clinical symptoms may help establish the diagnosis of brucella spondylodiscitis even if bacteriological examinations are negatives [1]. <h3>Reference</h3> [1]Bagheri AB, Ahmadi K, Chokan NM, Abbasi B, Akhavan R, Bolvardi E, Soroureddin S. The Diagnostic Value of MRI in Brucella Spondylitis With Comparison to Clinical and Laboratory Findings. Acta Inform Med. 2016 Apr;24(2):107-10. doi: 10.5455/aim.2016.24.107-110. Epub 2016 Mar 26. PMID: 27147801; PMCID: PMC4851511. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.